Eur J Cancer Care. 2019;e13029. wileyonlinelibrary.com/journal/ecc | 1 of 10 https://doi.org/10.1111/ecc.13029 © 2019 John Wiley & Sons Ltd 1 | INTRODUCTION Children and adolescents with cancer often experience multiple symptoms such as pain, sleep disturbances, fatigue, nausea, change in appetite and depression that negatively affect their Health‐ Related Quality of Life (HRQOL; Miller, Jacob, & Hockenberry, 2011; Nunes, Jacob, Adlard, Secola, & Nascimento, 2015; Rosenberg et al., 2016). Pain is a major problem for children with cancer, and its pres‐ ence and level varies during treatment (Calissendorff‐Selder & Ljungman, 2006; Dupuis et al., 2016; Sung et al., 2011), and even after treatment (Tutelman et al., 2018). Furthermore, children with cancer have experienced more pain from treatments and painful procedures than from the disease itself (Twycross, Parker, Williams, & Gibson, 2015). Pain is a multidimensional symptom that often in‐ cludes physical, psychological and emotional experiences (Enskär & Essen, 2007; Jacob, McCarthy, Sambuco, & Hockenberry, 2008). Unrelieved pain has negative psychological and physiological conse‐ quences, such as lower well‐being and HRQOL and impaired sleep (Calissendorff‐Selder & Ljungman, 2006; Ruccione, Lu, & Meeske, 2013). Sleep disturbances may be part of a cluster of symptoms that includes pain (Berger et al., 2005); both symptoms may represent Received: 30 June 2017 | Revised: 10 January 2019 | Accepted: 17 January 2019 DOI: 10.1111/ecc.13029 ORIGINAL ARTICLE Pain, sleep patterns and health‐related quality of life in paediatric patients with cancer Michelle Darezzo Rodrigues Nunes 1 | Lucila Castanheira Nascimento 2 | Ananda Maria Fernandes 3 | Luis Batalha 3 | Catarina De Campos 3 | Ana Gonçalves 3 | Ana Carolina Andrade Biaggi Leite 2 | Willyane de Andrade Alvarenga 2 | Regina Aparecida Garcia de Lima 2 | Eufemia Jacob 4 1 School of Nursing at Rio de Janeiro State University, Rio de Janeiro, Brazil 2 University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil 3 UICISA:E, Nursing School of Coimbra, Coimbra, Portugal 4 School of Nursing, University of California Los Angeles, Los Angeles, California Correspondence Michelle Darezzo Rodrigues Nunes, School of Nursing at Rio de Janeiro State University, Rio de Janeiro, Brazil. Email: mid13@hotmail.com Funding information Fundação de Amparo à Pesquisa do Estado de São Paulo, Grant/Award Number: 2010/20055‐6 and 2012/00091‐3; Fundação para a Ciência e a Tecnologia, Grant/Award Number: PTDC/PSI‐ PCL/114652/2009; Alex's Lemonade Stand Foundation for Childhood Cancer, Grant/ Award Number: P30NR005041; Canadian Institutes of Health Research Abstract Purpose: To compare sleep and health‐related quality of life (HRQOL) in children and adolescents with cancer who had pain, with those who had no pain during hospitalisation. Method: A prospective comparative study was used to collect data from paediatric oncology units in three countries (Portugal, Brazil, USA). Participants (n = 118; 8–18 years) completed the Quality of Life Inventory (PedsQL) Cancer module, which includes a pain subscale, and wore a wrist actigraph for at least 72 hr. Results: Almost half of the participants (48.3%) reported having pain. Sleep patterns were not affected by pain. Girls, adolescents and patients diagnosed with leukaemia/ lymphoma who reported pain, had significantly lower HRQOL scores. Low sleep du‐ ration and HRQOL were found, irrespectively of pain status. Conclusions: The low sleep duration and HRQOL score in children and adolescents with cancer highlight the importance of physical and psychosocial nursing interven‐ tions during hospitalisation. The mediating effect of gender, age and diagnoses on the relation between pain and HRQOL needs to be further understood. KEYWORDS adolescents, cancer, children, pain, quality of life, sleep